RESUMO
Between 1997 and 2012, the diagnoses of ankyloglossia and the indication for frenotomy increased by Ë800%. About 38% of diagnosed cases are surgically treated. Breastfeeding promotion includes evaluating maternal hereditary and personal history of breastfeeding, breast structure, endocrinological physiology, emotional well-being of the mother, breastfeeding technique, quality and quantity of milk, and the newborn's ability to latch on and suckle. Frenotomy would be indicated when restriction of tongue function causes difficulties that have not resolved after thorough evaluation and counseling to correct other causes. Frenotomy can have complications: feeding and respiratory difficulties, pain, weight loss, vascular or nerve damage, and delayed diagnosis of other underlying pathologies. It does not always solve breastfeeding difficulties. Interdisciplinary teamwork reduces the frequency of unnecessary frenotomies.
Entre 1997 y 2012 los diagnósticos de anquiloglosia y la indicación de frenotomía aumentaron Ë800 %. Alrededor del 38 % de los casos diagnosticados son intervenidos quirúrgicamente. La promoción de la lactancia materna incluye la evaluación de antecedentes hereditarios y personales maternos de lactancia, estructura mamaria, fisiología endocrinológica, equilibrio emocional de la madre, técnica de amamantamiento, calidad y cantidad de leche, capacidad del recién nacido de prenderse y succionar. La frenotomía estaría indicada cuando la restricción de la función lingual provoca dificultades que no se han resuelto luego de una evaluación exhaustiva y del asesoramiento para corregir otras causas encontradas. Las frenotomía puede tener complicaciones: problemas en la alimentación, respiratorios, dolor, pérdida de peso, daños vasculares o nerviosos, y retraso en el diagnóstico de otras patologías subyacentes. No siempre soluciona las dificultades de la lactancia. El trabajo en equipo interdisciplinario disminuye la frecuencia de las frenotomías innecesarias.
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Introdução: A laserterapia de alta potência tem estabelecido proporções satisfatórias na odontologia e se tornando a primeira opção de conduta cirúrgica para procedimentos, trazendo qualidade de vida aos pacientes e praticidade aos Cirurgiões. Objetivo: Relatar caso clínico de frenectomia lingual com uso do laser de diodo de alta potência ressaltando os benefícios da conduta. Relato de caso: Paciente sexo feminino, leucoderma, sem alterações sistêmicas, chega à Clínica Escola de Odontologia da Universidade Federal de Campina Grande, com queixa principal de alterações na sua fonologia. No exame intraoral observou-se dificuldade de movimentação lingual e em formato de coração devido a inserção fibrosa do freio, sendo observado a Anquiloglossia. Após explicações da alteração, do tratamento, e assinatura do Termo de Consentimento, foi iniciado a cirurgia: antissepsia, anestesia com vasoconstrictor, e em modo contínuo utilizou-se o laser de diodo de alta potência (TW Surgical- MMO®) configurado em 2W de potência, fibra 600µm, no comprimento de onda infravermelho, de modo que as fibras fossem separadas uniformemente e promovesse mobilidade imediata da língua, por fim realizou-se uma sutura em ponto simples com fio reabsorvível. Para o pós-operatório foi prescrito Dipirona em caso de dor, e estabelecido o acompanhamento. No retorno de 7 dias observou-se cicatrização normal e não ingestão do medicamento, em 30 dias foi visto a completa cicatrização e mobilidade sem desconforto, além de relato da paciente de melhoria na condição de relacionamentos sociais, autoestima e deglutição. Conclusão: O resultado apresentado neste artigo ratifica a benefício da escolha do laser em comparação ao convencional, demonstrando que não há sangramento no trans e pós cirúrgico, além de favorecer o processo de reparação tecidual, da redução do tempo cirúrgico, aumento do conforto, e diminuição de uso de medicamento, desta forma associando o laser cirúrgico a melhoria da qualidade de vida.
Introduction: High-power laser therapy has established satisfactory proportions in dentistry and has become the first choice for surgical procedures, bringing quality of life to patients and convenience to surgeons. Objective: To report a clinical case of lingual frenectomy using high-power diode laser, highlighting the benefits of this approach. Case report: A female patient, leucoderma, without systemic alterations, arrived at the Dental School Clinic of the Federal University of Campina Grande with the main complaint of alterations in her phonology. In the intraoral examination, difficulty in lingual movement and a heart-shaped tongue due to fibrous insertion of the frenum were observed, indicating Ankyloglossia. After explanations of the condition, treatment, and signing of the Informed Consent Form, the surgery was initiated: antisepsis, anesthesia with vasoconstrictor, and continuous mode using a high-power diode laser configured at 2W of power, 600µm fiber, at an infrared wavelength, with the aim of uniformly separating the fibers and promoting immediate tongue mobility. Finally, a simple suture was performed using absorbable thread. For the postoperative period, Dipyrone was prescribed for pain relief, and follow-up was established. At the 7-day follow-up, normal healing was observed, and the patient did not require the medication. At 30 days, complete healing and discomfort-free mobility were observed, along with the patient's testimony of improvement in social relationships, self-esteem, and swallowing. Conclusion: The results presented in this article confirm the benefits of choosing laser therapy over conventional methods, demonstrating the absence of bleeding during and after surgery, promoting tissue repair, reducing surgical time, increasing comfort, and decreasing the use of medication. Therefore, the use of surgical laser is associated with an improvement in quality of life.
Introducción: La terapia láser de alta potencia se ha establecido en proporciones satisfactorias en odontología y se ha convertido en la primera elección para procedimientos quirúrgicos, aportando calidad de vida a los pacientes y practicidad a los cirujanos. Objetivo: Relatar un caso clínico de frenectomía lingual con láser de diodo de alta potencia, destacando los beneficios de este procedimiento. Relato del caso: Paciente del sexo femenino, leucoderma, sin alteraciones sistémicas, llegó a la Clínica de la Facultad de Odontología de la Universidad Federal de Campina Grande con la queja principal de alteraciones en su fonología. El examen intraoral reveló dificultad en el movimiento lingual y lengua en forma de corazón debido a la inserción fibrosa del freno, observándose anquiloglosia. Tras explicar la alteración, el tratamiento y firmar el consentimiento, se inició la cirugía: antisepsia, anestesia con vasoconstrictor y uso continuado de un láser de diodo de alta potencia (TW Surgical- MMO®) configurado a 2W de potencia, fibra de 600µm, a longitud de onda infrarroja, para que las fibras se separaran uniformemente y favorecieran la movilidad inmediata de la lengua, y finalmente una sutura de punto único con hilo reabsorbible. En el postoperatorio, se prescribió dipirona en caso de dolor y se estableció un seguimiento. En el seguimiento a los 7 días, se observó una cicatrización normal y no se tomó medicación. A los 30 días, se observó una cicatrización completa y movilidad sin molestias, así como el informe del paciente de una mejora de las relaciones sociales, la autoestima y la deglución. Conclusión: Los resultados presentados en este artículo confirman el beneficio de la elección del láser frente a la cirugía convencional, demostrando que no hay sangrado durante ni después de la cirugía, además de favorecer el proceso de reparación tisular, reducir el tiempo quirúrgico, aumentar el confort y reducir el uso de medicación, asociando así el láser quirúrgico a una mejor calidad de vida.
Assuntos
Feminino , Adulto , Terapia a Laser , Frenectomia Oral , Cirurgia Bucal , Odontólogos , Relatos de Casos como Assunto , Freio LingualRESUMO
Ankyloglossia is considered a congenital patology, whose treatment indicated is a frenectomy, this surgical technique consists in remove the tissue that joins the tongue with the floor mouth. This technique allows the patient a considerable improvement to limitations caused by this anomaly such as difficulties in suction, pronunciation, chewing and difficulty in touching the lower lip with the tip of the tongue. Currently the use of laser technology and its benefits in modern dentistry, allows the realization of surgical procedures free of bleeding, with very little pain and inflammation of the tissues and with a recovery time much lower than necessary with conventional techniques. The present clinical case, show a 12-year-old patient with severe ankyloglossia, lingual frenectomy was indicated. A contact Nd: YAG laser was used, achieving a surgical intervention with little pain, free bleeding and without suture.
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The aim of the study was to evaluate the release of the lingual frenulum through frenectomy in newborns zero to 90 days of age who breastfed and had diagnosis of ankyloglossia with an indication for surgery, comparing two methods: electrocautery and a high-power diode laser. Fifty-seven patients were randomly allocated to two groups (23 submitted to electrocautery and 34 submitted to a high power diode laser). Tongue movements were evaluated based on a clinical assessment and using the Bristol Tongue Assessment Tool (BTAT) before and 15 days after the surgical procedures. The visual analog scale was administered to the mothers on the same occasions for the measurement of pain during breastfeeding. Both groups had an increased BTAT score (favorable outcome) at the post-surgical evaluation, but the anterior third of the tongue was not always free to enable the movements necessary for lingual functions. It is fundamental for surgeons to have skill and in-depth knowledge of the equipment used to avoid accidents and complications in the region of important structures. Both techniques employed in this study were safe and effective, causing little bleeding and few postoperative complications. The group submitted to a high-power diode laser exhibited less post-surgical bleeding compared to the group submitted to electrocautery and no inflammation at the edges of the surgical cut.
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BACKGROUND: There is a controversy in the literature concerning the indications for frenectomy to treat interincisal diastema. Aims and Objectives: The aim of this study was to evaluate the spontaneous closure of the interincisal diastema in patients submitted to upper labial frenectomy (ULF) during the mixed dentition. MATERIALS AND METHODS: Records from patients treated between 2009 and 2014 in the course of Pediatric Dentistry Surgery at Fundecto-USP were evaluated to select those that were submitted to ULF during the mixed dentition using the Chelotti technique. Initial clinic characteristics and radiographic data related to the abnormal upper labial frenum were collected. The patients were called for a return visit to evaluate the diastema closure. The prevalence of children with diastema reduction after the frenectomy was determined by descriptive analysis. Logistic regression was used to evaluate the association between exposure factors and diastema reduction. Results: From 449 eligible records, 53 were selected and 25 were in a return visit. It was not possible to find association between the exposure factors and diastema closure. CONCLUSION: There is no relation between the time of surgery intervention and diastema closure. However, the intervention during the mixed dentition led to a partial diastema reduction in 80% of the cases.
Assuntos
Diastema , Freio Labial , Criança , Dentição Mista , Humanos , Freio Labial/cirurgia , Odontopediatria , PrevalênciaRESUMO
Las estrategias para el éxito en la rehabilitación bucal requieren de la interrelación de varias disciplinas que en conjunto logren resultados predecibles y duraderos. La visión individualizada de cada área de especialidad puede conllevar a no ofrecer la mejor alternativa de tratamiento, es por ello que la valoración, el diagnóstico y la planificación del caso clínico debe ser realizada por un equipo interdisciplinario para evitar esta situación y crear una sinergia en donde el «todo sea mayor que la suma de sus partes¼. El objetivo de este trabajo es presentar un caso clínico en el cual intervinieron varias áreas de especialidad: periodoncia, prostodoncia, cirugía oral y patología bucal, logrando devolver la función y la estética a través del manejo interdisciplinario (AU)
The strategies for success in oral rehabilitation require the interrelation of several disciplines, which together, achieve predictable and lasting results. The individualized view of each specialty area may lead to not offering the best treatment alternative, which is why the assessment, diagnosis, and planning of the clinical case must be carried out by an interdisciplinary team to avoid this situation and create a synergy in where the «whole is greater than the sum of its parts¼. The objective of this work is to present a clinical case where several areas of specialty intervened: periodontics, prosthodontics, oral surgery, and oral pathology, thus achieving the return of function and aesthetics through interdisciplinary management (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Procedimentos Cirúrgicos Pré-Protéticos Bucais/métodos , Reabilitação Bucal , Periodontite/terapia , Faculdades de Odontologia , Satisfação do Paciente , Fotografia Dentária , Planejamento Antecipado de Cuidados , Prótese Total Imediata , Estética Dentária , Aumento do Rebordo Alveolar/métodos , Freio Labial/cirurgia , MéxicoRESUMO
OBJETIVO: El propósito de esta revisión fue evaluar sistemáticamente la literatura científica sobre los resultados clínicos que se obtienen al remover los frenillos aberrantes al utilizar los procedimientos quirúrgicos convencionales y el láser. MATERIALES Y MÉTODOS: Búsqueda detallada en las bases de datos PubMed, ScienceDirect, Cochrane y SciELO para obtener la información más actualizada los resultados clínicos (dolor posoperatorio, dolor al hablar, dolor al masticar y complicaciones posquirúrgicas) entre las técnicas convencionales (uso del escalpelo) y las técnicas de remoción con el láser (búsqueda de ensayos clínicos). RESULTADOS: De los 501 archivos identificados inicialmente, se excluyeron reportes clínicos, revisiones, estudios observacionales, comentarios, estudios con pacientes pediátricos, etc. Se incluyeron cuatro ensayos clínicos que contrastaron las variables entre la técnica convencional y las técnicas con el láser Nd: YAG y láser CO2 CONCLUSIÓN: La percepción del dolor posoperatorio, el dolor al hablar y el disconfort al masticar luego de la frenectomía es menor en las técnicas que utilizan el láser de Nd: YAG y CO2 frente a las técnicas que utilizan el escalpelo. El tiempo quirúrgico con el uso del láser es significativamente menor que al utilizar el escalpelo. La heterogeneidad de los estudios limita la realización de un metanálisis con respecto a los resultados.
OBJECTIVE: The purpose of this review was to evaluate systematically the scientific literature on the clinical results obtained by removing aberrant frenulums using conventional surgical procedures and laser. MATERIALS AND METHODS: A detailed search was performed in the PubMed, ScienceDirect, Cochrane and SciELO databases to obtain the most up-to-date clinical results (postoperative pain, pain when speaking, pain when chewing and postoperative complications) among conventional (scalpel use) and laser removal techniques (search for clinical trials). RESULTS: Of the 501 records initially identified, clinical reports, reviews, observational studies, comments, studies with pediatric patients, etc. were excluded. We included four clinical trials that contrasted the variables between the conventional technique and the techniques with the Nd: YAG laser and CO2 laser. CONCLUSION: The perception of postoperative pain, pain when speaking and chewing discomfort after frenectomy is lower in the techniques using the Nd: YAG and CO2 laser versus the techniques using the scalpel. The surgical time when using of laser is significantly lower than when using the scalpel. The heterogeneity of the studies limits the performance of a meta-analysis with respect to the results.
Assuntos
Humanos , Procedimentos Cirúrgicos Bucais/métodos , Freio Labial/cirurgia , Complicações Pós-Operatórias , Cirurgia Bucal , Dióxido de Carbono , Resultado do Tratamento , Terapia a Laser , Lasers de Estado Sólido , Duração da CirurgiaRESUMO
La aplicación del LÁSER (light amplification of stimulation emision of radiation) en las áreas de la medicina y la odontología viene demostrando una constante evolución, brindándonos alternativas a los tratamientos convencionales. Los láseres quirúrgicos de tejidos blandos muestran grandes ventajas comparados a los procedimientos habituales de corte, ya sea con bisturí frío o electrobisturí. La mínima necesidad de anestesia, la analgesia intra y postoperatoria, la coagulación inmediata, la cicatrización por segunda, el efecto bactericida, la ausencia de puntos de sutura, el confort postoperatorio, son algunas de las ventajas que hacen que la cirugía con láser sea una opción indiscutible que está ganando terreno entre los profesionales de la salud (AU)
Assuntos
Humanos , Feminino , Criança , Eletrocirurgia/métodos , Aparelhos de Tração Extrabucal , Lasers , Freio Lingual/cirurgia , Má Oclusão Classe III de Angle/terapia , Equipe de Assistência ao Paciente , Argentina , Faculdades de Odontologia , Fonoterapia , Cicatrização , Técnica de Expansão Palatina , Resultado do Tratamento , Aparelhos Ortodônticos FuncionaisRESUMO
Introdução: A anquiloglossia é uma anomalia congênita que envolve alterações morfofuncionais no frênulo lingual e que pode estar atrelada às condições genéticas; apresentando-se em maior frequência no sexo masculino; e caracteriza-se por limitar os movimentos linguais. Com isso, pode contribuir na disfunção do sistema estomatognático, desencadear prejuízos na amamentação e comprometer o desenvolvimento craniofacial do neonato. Objetivo: As divergentes opiniões encontradas promovem um quadro de incerteza na escolha do protocolo de avaliação ou na intervenção, impulsionando assim a realização deste artigo. O presente artigo objetivou revisar a literatura de modo a desenvolver o conhecimento nos protocolos de avaliação para o diagnóstico da anquiloglossia, analogamente verificar as interferências condicionadas por esta anomalia no sistema estomatognático e observar as formas de tratamento para liberação do frênulo lingual. Materiais e Métodos: Foi realizada uma revisão de literatura de estudos anteriores com acesso possibilitado pelo PubMED/Medline, Lilacs, Scielo, Scopus; estabelecido o critério de artigos recém-publicados, no intervalo de 2015-2019. Conclusão: Assim, a ausência de um método de identificação que se enquadre em um padrão ouro revela a necessidade de realização de mais estudos sobre um protocolo mais eficaz para diagnóstico e classificação dessa anomalia, pois um método com maior nível de exatidão evitará intervenções inoportunas, e promoverá o conhecimento básico para realização do tratamento adequado para cada quadro de anquiloglossia.
Introduction: Ankyloglossia is a congenital anomaly involving morphofunctional changes in the lingual frenulum and which may be linked to genetic conditions; presenting more frequently in males; it is characterized by limiting lingual movements, which can contribute to the dysfunction of the stomatognathic system, triggering losses in breastfeeding and compromising the craniofacial development of the newborn. Objective: The divergent opinions found promote a picture of uncertainty in the choice of the evaluation protocol or intervention, thus driving the realization of this article. This article aimed to review the literature in order to develop knowledge in the assessment protocols for the diagnosis of ankyloglossia, similarly to verify the interferences conditioned by this anomaly in the stomatognathic system and to observe the forms of treatment for release of the lingual frenulum. Materials and Methods: A literature review of previous studies with access made possible by PubMED / Medline, Lilacs, Scielo, Scopus; the criterion for newly published articles in the 2015-2019 range was established. Conclusion: Thus, the absence of a gold-standard identification method reveals the need for further studies on a more effective protocol for diagnosing and classifying this anomaly, as a more accurate method will avoid inappropriate interventions, and will promote the basic knowledge for carrying out the appropriate treatment for each ankyloglossia picture.
Assuntos
Anquiloglossia , Doenças da LínguaRESUMO
RESUMEN: El uso del láser de baja potencia en odontología está siendo cada vez más frecuente y con excelentes resultados, los equipos más modernos traen pre-establecidos la dosimetría de los parámetros para las diferentes acciones clínicas. El objetivo de esta revisión fue encontrar evidencia científica que permita al clínico tener como una alternativa de tratamiento el uso del láser de baja potencia en patologías orales de tejidos blandos y duros en pacientes pediátricos. Se realizó una revisión de la literatura por medio de buscadores como PubMed, LILACS y SciELO. Después de leer a texto completo todos los trabajos es posible señalar que el láser de baja frecuencia es una buena alternativa terapéutica en la resolución de signos y síntomas en patologías orales que aquejan al paciente pediátrico, puesto que, presenta un rápido control del dolor, la inflamación, el sangrado y acelera los procesos de reparación celular.
ABSTRACT: Low Level Laser Therapy in dentistry is becoming more frequent and has had excellent results, with state of the art equipment having pre-established dosimetry parameters for the various clinical actions. The objective of this review was to find scientific evidence that allows the clinician to have the use of low power laser as treatment alternative, in oral soft tissue and hard pathologies in pediatric patients. A review of the literature was performed through search engines such as PubMed, LILACS and SciELO. After reading the texts, it was possible to point out that low frequency laser is a good therapeutic alternative in the resolution of signs and symptoms in oral pathologies of the pediatric patient. This alternative allows for rapid pain control, reduces inflammation and bleeding, and accelerates cellular repair processes.
Assuntos
Humanos , Criança , Estomatite Aftosa/terapia , Úlceras Orais/terapia , Terapia com Luz de Baixa Intensidade/métodos , Sensibilidade da Dentina/radioterapia , Lasers Semicondutores/uso terapêutico , Resultado do Tratamento , Odontopediatria/métodos , Terapia a Laser/métodos , Freio Labial/cirurgiaRESUMO
This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Freio Lingual/cirurgia , Anormalidades da Boca/cirurgia , Lasers Semicondutores/uso terapêutico , Doenças da Língua/cirurgia , Resultado do TratamentoRESUMO
O freio labial superior hipertrófico ou de inserção anômala pode causar transtornos funcionais como a limitação da movimentação do lábio, dificuldade de higiene bucal, retração da margem gengival e também estéticos, quando associado com linha de sorriso alta e diastemas. O procedimento comumente utilizado para tratar o freio labial anômalo é a frenectomia. Embora tenha sofrido modificações ao longo do tempo, nenhuma das técnicas conhecidas de frenectomia considera a faixa de gengiva inserida, e não são indicadas em casos em que a remoção do freio pode comprometer a estética. Este relato de caso demonstra uma técnica para manuseio estético de freio labial superior hipertrófico e de inserção transpapilar, associado com diastema amplo, na qual a gengiva inserida foi preservada, a cicatrização se deu por primeira intenção, obtendo-se ótimo resultado estético com mínimo desconforto pós-operatório.
The hypertrophied upper labial frenum or abnormally inserted frenum may cause functional disorders such as limited movement of the lip, impaired oral hygiene, retraction of the gingival margin, as well as lack of aesthetic when associated with high smile line and diastema. The most commonly used procedure to treat anomalous labial frenum is frenectomy. Although it has undergone to several modifications over time, none of them considers the attached gingiva zone and are not indicated in cases where the removal of the frenum can compromise aesthetics. This case report demonstrates a technique for aesthetic management of a hypertrophic upper labial frenum with transpapillary insertion associated to wide diastema in which the attached gingiva was preserved. Healing occurred by first intention, resulting in excellent aesthetic results with minimal postoperative discomfort.